Follow the steps to complete the evaluation request form.

1. Press the ‘Get Form’ button to access the evaluation request form and open it in your digital document editor.
2. Begin by entering the name of the individual in the designated field labeled 'Name of Individual.' Then, provide the DDD ID number in the corresponding area.
3. Next, indicate the date of your request in the 'Date of Request' field.
4. Select the agency you are requesting the evaluation from by filling in the agency name in the section titled 'Agency requested for evaluation.'
5. In the 'Cost' field, state any associated costs for the evaluation services, if applicable.
6. Explain the purpose of the evaluation in detail in the designated space. Be clear and thorough in your description.
7. Provide a detailed account of the services needed in the next section. Specify what assistance or modifications are being requested.
8. Fill in the 'Completed by' section with your name, and then enter the date of completion.
9. The form contains sections to be completed by the Division of Developmental Disabilities, which will indicate whether the request has been approved or denied.
10. If the request is denied, additional space is provided for reasoning and/or information required for approval. Note any feedback or requirements here.
11. Finally, review the entire form for completeness and accuracy, then proceed to save your changes, download, print, or share the form as needed.

Complete your Assistive Technology/Environmental Modification Evaluation Request Form online for timely support.